CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Memorial Hermann Houston Physicians Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $4,773
Cash Discount Price: $10,806
vs. Medicare Baseline: 0.34x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Memorial Hermann Houston Physicians Hospital is $4,773. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,806. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.34x the Medicare baseline. Located in 333 N Texas Avenue, Suite 1000, Webster, TX.

Cash / Self-Pay

$10,806

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,773

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $10,806 (77%)

Insurance Median: $4,773 (34%)

Cash: $10,806 (77% of Medicare)

Ins. Median: $4,773 (34% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
American National Insurance	$1,413 - $105,039	10%
Health Smart	$1,413 - $105,039	10%
Advantra Freedom McR Replace	$9,823	70%
Aetna	$9,823 - $18,374	70%
Medicare (plans)	$9,823	70%
Coventry Health Care - McR	$9,823	70%
Devoted Health	$9,823	70%
United Teachers Association	$9,823	70%
Banker Life and Casualty	$9,823	70%
Humana	$9,823 - $10,806	70%
Health Spring	$9,823	70%
Texan Plus	$9,823	70%
Blue Cross Blue Shield	$9,823 - $10,806	70%
Advantra Freedom	$9,823	70%
Aarp	$9,823	70%
Pffs	$9,823	70%
Kelsey-Seybold	$9,823	70%
Wellcare	$9,823	70%
Cigna	$9,823 - $22,109	70%
Gpa	$9,823	70%
Kelseycare Advantage	$9,823	70%
Unicare-McR Replacement	$9,823	70%
Tricare	$9,823	70%
UnitedHealthcare	$9,823 - $10,806	70%
Other	$10,806	77%
Texas Health Spring	$10,806	77%
Champva	$10,806	77%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $10,806.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Memorial Hermann Houston Physicians Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 470.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.